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Join us for session 4 of our OSCE Series as we go through counselling patients pre-operatively. Pick up in key communication skills and strategies to approach discussions with patients awaiting surgery.

Keep an eye out for further details and catch up content!

Teams Meeting ID: 346 501 225 979

Passcode: XqRj57

https://tinyurl.com/osceexpress

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Hi, Ron. We'll make a start down. Can I just check that? You can all hear me? Yeah. Yeah, thumbs up. Great. So, um welcome to the Oscar Express uh series session number four. with a new face this week, Doctor Holly Garcia Poly is great. She has my F one during medicine block. So I can personally say that she'll uh you know, deliver a really good session. She super helpful as well and she'll give you really uh sort of good advice for how to tackle the stations that we'll talk about today. Um I'll just introduce the course again as I do every week for people who are joining us for the first time. So for the disclaimer of the first that um this course has been designed to help finally medical students with Os prep and it's not meant to replace university teaching. It's not meant to be supplementary medical advice. It is peer reviewed by junior doctors, but we take no responsibility for the accuracy of the content. If you don't notice any errors, please message us at the email and we'll swiftly correct it. So it's essentially a, a group of junior doctors working together to put out these sessions to better prepare you for finals acies. And the way we kind of structure every week is we'll go through um how to approach the station, common presentations, common um scenarios that you can expect top tips, pitfalls in the stations. Um And then we'll go through a example case or a couple of example cases depending on the session. So it's a 11 sessions. We're on session number four now and then all the case outputs will be published on a case.com. Just a couple of things to address from previous weeks. I know a couple of people have said that the audio wasn't working on the recording from last week. So I've taken that video down and we're going to sort it out and reupload it so it should be working after today. Um And I know this is still the cases from session, one haven't been uploaded yet, but because they have to be filmed, we're still working on sorting out time when everyone's free for that. But rest assured by sort of January or February time, we should have a substantial bank of cases just specifically for final Zoky. And the point is to prepare you for ay, but there's also this um you know, um underlying theme of preparing you all to be safe at once, which is, is really what Zoky are all about. So in today's uh session, just one station this week. So we're gonna be looking at preoperative care going through three example cases and then uh Holly will stay back for a little while at the end just to answer any general ask you questions that you have. So I will hand over to her to begin, ok? But keep putting, keep putting your questions in the chart. We might not address them there and then, but we'll go through all of them by the end of the session. All right. Thank you so much. Um I hope everyone can hear me. OK. Um So yeah, I'm covering this station, pre op care. Um It's actually a very easy station as long as you have a good structure. So that's kind of what I'm gonna go through today. Um I feel like most ay stations, if you have a good structure and you go in with it knowing what questions you want to ask, then you'll be all right. Um So yeah, this is kind of the layout of the station. So it's a simulated and you're in a pre op assessment clinic, they'll tell you. So you have 10 minutes now. It's quite a lot to cover in 10 minutes. So I think this is why having a structure is so important because you've got a lot of stuff to get through. Um So you want to talk to the patient about kind of the operation, including the indication, the risks and the benefits. One of the feedbacks they said from kind of two years before or the year before I did. My oy was lots of the final years. Didn't actually talk about the benefits, like they'd go into detail about the risk, but they wouldn't talk about the benefits. So that's just something to be aware of that. They kind of picked up on, on one of the, um, stations. Um, so then you want to do that, you also want to be able to take a history, um, see if they need any investigations or anything prior to the operation. Look at kind of what medications they're on, see if any of them needs to be stopped or changed. You've probably seen it in kind of like third year in your surgery block of things that need to be stopped before surgery. Um, and then kind of talking a bit about what's going to happen on the day and the recovery. It's nice for patients to know, you know, how long they might have to be out of work if it's going to need any follow ups, um, or driving, like lots of patients will be quite concerned about whether or not they can drive. So, yeah, that's kind of the layout. This is from your a briefing. So this is what it's assessing. So it's assessing your communication skills. Kind of knowing a bit about the operations. I wouldn't, I wouldn't be too worried about kind of knowing operations in great detail. I think if, you know, like some risks and, um, some of the, like why you're having it, I mean, you probably will know why you're having the operation and normally as well just ask the patient and they will tell you. Um, yeah, so that, um, recovery time, um, the investigations is really important and then kind of nil by mouth medication stopping. So that's, yeah, that's basically what they're assessing you for. And then this is just kind of the Mark scheme. So again, the reason why they're attending mention the investigations, mention the medication changes if you need to and then just I think be quite nice. Well, you won't be always be nice in ay, but just kind of make it quite personal about them. Like I'll tell you some tips like later on, but you'll, you'll see what I mean later. Ok. So this is my approach. So what I did when I was practicing for my final year, os, I would basically have something like this for every single station and I would memorize this. So that before the station, when me and my friends would practice, I would write this down. And this is what I would do. You can obviously change the order depending on kind of how it's going. But as long as you kind of cover this, then you've kind of hitting all the Mark scheme points. And obviously yours is very important about trying to develop you as a to be a capable f one doctor but also in the exam you're trying to hit, it's a tick box, you need to hit the points so that they're happy to be like, oh they covered this, this and this. So the first way. So how I'd approach it. So firstly say what this clinic is. So ask them what they know about why they've been brought here and just explain a bit about what the clinic is. So you can introduce saying you're here today because you're having this operation in this clinic. We're going to talk a bit about you, your medical history, talk a bit about the surgery. See if there's any kind of test that we need to do before the surgery. Is there any medication changes that we need to make? And then also talk a bit about what's going to happen on the day and your recovery afterwards. So that's just introducing it. It's nice so that the examiner can be like, oh, they know exactly what they want to cover. II, do this quite a lot in all my ay stations because then if you do run out of time at the end of it, at least you've mentioned it at the beginning. So they know you were going to cover that, but you might have just run out of time. I mean, you don't want to run out of time, but if you do II feel like that's quite a nice thing to have done. Um, yeah, so then what operation are they having? So ask them why they're having the operation. Um You can be like, ok, so this is the benefit of the operation. Um You understand this risks, I don't think you need to go into great detail, most risks for operations, bleeding, infection. Um I think it's quite nice to kind of say how you're going to minimize the risks as well. Um, but I always used to cover my back and if I didn't know kind of the ins and outs of the surgery, I'd say on the day, um, the surgeon who's doing the surgery and an anesthetist will come and talk to you about the operation, make sure that it's all properly consented and can discuss any questions you have and go through all the risks, um, with you because then you're still kind of covering your back there. Um, so that if you don't mention every single risk, you've said that it will be properly discussed because at the end of the day when someone is consenting for surgery, it normally has to be someone who can do the surgery. So you as an F one, you won't be doing the surgery, so you wouldn't be expected to know all of the risks. Um, yeah, so that's that part. Then you go on to kind of the history thing. So you're wanting to take a very brief history most of the time in Aussies. I mean, it's not like real life in real life. They have about 10 million medical conditions and they're on thousands of, you know, medications and they've got a really complex social history and all of that normally in acies, they tell you the important things. So they'll probably have two conditions and then they will mention them because they are on two medications that you might need to alter prior to the surgery. So, just take it really briefly, social history. Just ask who's at home because if they're having a surgery, have you got support at home? Will they be able to, you know, pick you up? Will they be able to, if, if it's a major surgery, will they be able to kind of look after you and help you? Um, and then you do want to include kind of previous surgery. So, have they ever had anesthesia before? Have they had any complications? Anything like that? Just because, well, that will kind of like tailor the consultation. Um, so then after I've done that, then I went on to medication changes. So, because I'd got all that history, I'd say, ok, so these medications that you're on, we're gonna have to change them and then what's happening on the day. Um, yeah, and then I'll go into this in more detail and then kind of recovery and then I did investigations last. Some people like to put them up there because I know it's a tick box kind of thing. And you need to say that, but I did it last because I'd kind of include it in my, what's going to happen on the day and then just before you need these investigations. So, yeah. Ok. So these are kind of some common procedures. Now, this is not a massive list of every single procedure they could ask you, they could do anything to be honest. Um, but these are just some of the common ones. It's a pre op assessment. So it's going to be an elective procedure. It's not an emergency procedure. So these are some of the few that I've kind of mentioned. I think our one was a hysterectomy from memory, but I'm not completely sure. Um But yeah, these are just a few just in case you wanted to kind of look into them in a bit more detail. But honestly, if you don't have time, I wouldn't waste your time on that. Like there's a lot more complicated stations that you'll probably want to put more time into. Um But yeah, so these are just a few. So all your joint replacements. Um You're kind of your cholecystectomy, your colectomy, your splenectomy, um and then your gyne stuff and then just some urology. I don't think they do urology. I think that'd be quite mean. Um But yeah, just know a bit about kind of how they do the procedure, whether it will be general anesthetic or spinal anesthetic. Um whether it's um open procedure or keyhole because that's quite a nice thing to know. Um just for the patient. And then yeah, so I said about risks. So the main ones, bleeding, infection pain, um just be like pain. Yes, we know this can be painful, but we'll make sure that you've, you know, got pain relief prescribed and that we'll monitor your pain. We like to score it just, I think these little personal things make it a bit. I don't know, I feel like the patient just, well, the actor appreciates it. Um just because you're kind of reassuring them as you go along. Um other ones, damage to nearby structures. I mean, that's an easy one you can throw in there, but you can be like, you know, it's being done by a surgeon who's done this multiple times before and it's a small risk, but it is a risk we have to tell you about. Um, and then other kind of risks. So DVT um anesthetic risk, but like I said, you don't need to know every single risk. You're not going to be going into all the complicated stuff that can happen because to be honest, you won't have time, like 10 minutes isn't very long to do all of this. Um So you can just say the surgeon and the anesthetist will kind of take you through things on the day as well just to reassure them that, you know, they'll get even more information and also I'll put this in my top tips. So I'm going to out just say you'll give them a leaflet. Like, it's such an easy thing. I should do it for every single I'm like, oh, I'll get you a leaflet about that. I mean, you don't actually have to get them a leaflet, but if you say you've get them a leaflet, then they'll have more information on that. Ok. So medications. So this is the main thing you kind of need to know. This is like knowledge that you have to know because they will bring something, they will, the patient will be on something that you have to alter or you have to stop. So these are all the ones that I could really think of. I don't think there's any kind of more the diabetic ones are quite complicated and I think it would be quite harsh for them to do that if in doubt and you don't know, say you will check and that you let them know or that you will speak with your senior because if you're aware that it needs to be altered, but you don't know exactly how it's better for you to say that you need to check. Um rather than giving them something completely random that is incorrect. So just say you'll check it. So, yeah, so the pill and HRT is four weeks before. Um Clopidogrel is seven days. Warfarin is five days. Um But we normally bridge them with um like Delta. So yeah, just be aware of that, that they might have to have injections to bridge the Warfarin. Um Doac 48 hours. Um The Delta is 24 hours ace inhibitor and Arbs 24 hours and steroids is about kind of on sick days. Increasing. Their steroids are making sure that they've got enough to cover it, but you can obviously say that you'll discuss and make sure that they're covered for that. Um, things to start. So most surgery placements will be, if they, well, if it's not a day case, if they're staying for longer, they'll be started on Darin, um, and head stockings. Um, so you can say that we're going to kind of reduce the risk of any dvts or blood clots in the legs or lungs. Um, and also antibiotics for any kind of like joint surgery or, um, normally it's in like general surgery as well and just so that they know that they are covering against infection. So this is the diabetics one. So me and my friend when we were revising for this, we were kind of struggling with the diabetes drugs because it is quite complicated and this is what we've come up with. So you might want to check it, but we did a lot of kind of looking around and seeing what was done. I mean, thank God they didn't ask us. But, um, if they do this is what we've kind of figured out. So basically you continue all of the glitazones, the Gliptin and the exenatide. If it's glycoside, you stop it and glycosine on the day of surgery. So that's to stop if they're on insulin. Um, so if they're on it once a day, you reduce the doses the day of and the day before, if they're on it twice a day, you just reduce the day off. So not the day before. And the basal bolus, you admit the short acting, but you continue the long acting because if you think about it, they're not eating, um, prior to surgery because of the whole being like nil by mouth and everything like that. So you don't want them to go into hypos, but it's quite complex. So honestly, if you don't know, just say, I think that some of your diabetic medications might be changed on the day of surgery or the day before surgery, but I will look this up. Yeah. Well, just see the on the chat about Metformin. This is the thing. There's so much. So some people say to continue Metformin, some people say to stop Metformin. I mean, if any of you can find the real thing, me and my friend, literally, while we were revising for Os were searching this for ages and we actually gave up in the end. Um, because there's lots of different information on it. I think at the end of the day, like you can check with the um, whoever's doing the surgery or you can check with kind of, um, diabetic nurses. Like, they might have more information on it. But, yeah, if you find the information, let me know because I'm actually not too sure about that. So that's one thing I never, um, actually managed to find out. But, yeah, I think, yeah. So that's the main drugs if they gave you diabetes. I mean, it would be quite harsh. Um, but I don't know, they might do so just so that, you know, um, but I would double check that because I've never really found out the true answer, but that's as much as I found out. Ok. So then I talked about the kind of thing about on the day. Now, this is where I like to make it a bit more personal. Um, so I like to kind of make it, I feel like if I was going for a surgery I'd kind of want to know exactly what's going to happen. So that's what I did for my oscopy for my patient. And I felt like in my feedback, they said that it was nice for me to kind of go through the little things and stuff like that. So, what I'd say is, um, you'll be given a time to arrive on your letter. This might not be the time of the surgery. It is just the time arrives so we can make sure that everything is ok and that you're there for when the surgery is to go ahead. Um, because of this, you might be waiting around for quite a bit of time. Um, so it's probably quite good to bring yourself a book or something to entertain yourself. Um, make sure you bring some comfy clothes, bring your slippers. Um, just so I feel like that's just quite a nice thing to kind of say to them. Just so then they're aware that they might be waiting around for a bit. Um Then you say normally before the surgery, the anesthetist and the surgical team will come up and speak to you, they'll want to consent you fully for the procedure. Um, because I'm not consenting you here today, they'll be able to talk to you a lot more in detail about kind of the operation that you're having the risks and the benefits. And also if you wanted more detail of exactly how the operation was going about, um, then they'll be able to do that for you. Um You can talk a little about, about the operation here. So for example, like if they're having a knee operation, if you knew or a hip replacement or I know if they were like on the spinal anesthetic, then you can be like, oh, you would be numb, so you would be awake during the surgery. Um, and they'd be making an incision and um replacing the joint um with some artificial metal basically. So you can do it like very basic, do it very like layman terms. Um, for them, we're not going to care about how well some of them might, but they don't need to know the exact in depth. Um, just kind of explain. Is it an open surgery? Is it, um, keyhole surgery? You could also say that, um, there is a risk that if you are having a keyhole surgery, it may need to change to open surgery. So, just to, um, make you kind of aware of that, that, that is something that could occur. Um, yeah, and then also say before the surgery you will be near by mouth. So six hours for food and two hours for, um, clear liquids. Um, so, yeah, and also they may need bowel prep. Um, if it's kind of a, um, gen search thing, but I mean, I don't think they'd give you a gen surge one. But yeah, you can just say that, you know, you may need to require to take some laxatives so that your stomach is empty before, um, the surgery is done. Um, but that will all kind of be explained. Um, I've put in just a little thing. It's just from, um, teach me surgery. So they've got a whole bit on like bowel prep and what's needed for different surgeries. So you can have a look at that in your own time. Um, but again, I don't think they'd ask that, but just in case. So the anesthetist won't do the full consent. So the consent for the surgery would be by the surgeon. I'm sorry, it's just a question saying would the anesthetist do the full consent? So it's normally the surgeon that does the consent for the surgery, but the anesthetist will come and kind of do you know their scoring of their mouth and see what kind of airway they'll need if they need that. So they'll be seen by both the anesthetist and the surgeon. But consent as an F one. You don't really do. I haven't heard any F one do it. I think there's kind of a thing about if you're consenting someone for surgery, you should be able to do the surgery so that you can fully kind of explain it. What do you mean about stitches and staples? Um, I don't know what you mean. Oh, what as in like more detail, I don't know what that means. I'll let it to clarify. Um Yeah. So then, then, so after they've kind of had the surgery, I like to say so normally, then we'd bring you down to the surgery. Um, the anesthetist would be there to kind of um, they ask about stitches that they get. Yes. Then they're not gonna ask about anything like that. That's what I mean. They won't, they won't really go into detail. But if they do want to ask something about stitches or anything, you can be like the surgeon will be able to give you more information about that because that you don't need to go into detail about that. Um, yeah. So then you'd say you're going to go down to the surgery, you normally get taken into a separate room where the anesthetist will either administer kind of the anesthetic into your spine or will put you to sleep. Um, you'll be getting lots of other medications as well for pain relief and also to make you feel less nauseous as well, um, you'll then have the surgery after your surgery. We normally take you to a recovery room. So it's like a recovery ward so that we can make sure that everything's ok and that you, you wake up. Ok. Um, and that we're controlling kind of any symptoms of pain that you're having. Um, and then you'll be taken up to the ward and then it depends if it's kind of day case or if they're staying over. So again, if you don't know exactly, you can be like you might be assessed and see whether you can go kind of home or we might have to keep you in a few days depending on how the surgery goes and how, also how you're faring. Um, then you want to say when you do go home, you've already asked in your history about kind of, have they got anyone at home? Have they got any support? Um, so you can kind of clarify, um, So you might have to rest for a couple of weeks. Have you got someone there, um, to look after you, blah, blah, blah. And then, um, the other thing is kind of returning to work driving, doing like things like heavy lifting and stuff like that. So if they've had like an abdominal surgery or in terms of any kind of surgery, they're not really going to want to do heavy lifting straight away. It's normally kind of like four weeks. We, um, we say driving wise, I know there's like certain kind of rules with the D VA and stuff. I think most of the time in surgery. What I said, as I said, you know, before you drive, you need to be able to active, you need to be able to basically perform an emergency stop and you need to not be in pain, your seatbelt needs to fit comfortably on you. Um, you should be able to fully maneuver and everything so it could be four weeks. It depends on how your recovery kind of goes. But, you know, they shouldn't be driving straight away after they've had the surgery, especially kind of if they had a knee replacement or anything, they're not going to be able to drive. Um, again, there's probably online somewhere, there's probably some specifics about it. I don't think it's anything you should kind of worry about. If you want to do extra research on that, then you can. But I wouldn't say it's something you should focus on. It should just be a kind of acknowledgement to you might not be able to drive for a little while. Um, and it might take you, um, you know, a while to get back to that also with work again. It, it does depend on the surgery. Um, I know kind of with patients on our ward. I'm not on the surgery at the moment, but we normally give them a sick note for 1 to 2 weeks after they've had kind of a medical condition. Obviously, it depends what work they do. You will have kind of figured that out in their social history. You know, what, what job it is that they have if they are a builder and they've had a knee replacement and they're not going to be able to do that if they work from home on their laptop, you know, they might only need maybe a week or two weeks off. So it is very dependent, um, about that. But just mention, you know, you might need some time off and then unless they have further questions about it, then you can kind of go into more detail about that. Ok. So I think this is the last kind of bit. So it's kind of investigations. Um, so basically you need to be able to justify every investigation that you kind of put forward to them. It's mainly blood pre op. So you're wanting to do a full blood count using knees and LFTs. So you're wanting to do it because you need to know kind of their bloods before they have the operation to make sure that you know what their baseline function is. Um renal function. You need to know this because if they are going to be having fluids or they're going to be having any analgesia, you need to know what dosing you need to give. Especially also, like if you're giving them antibiotics, you need to know if it needs to be renal dosing. So you need that baseline um group and save and cross match is also something that you can kind of just throw in there. So the patient might need a transfusion like you don't know. So you can just, I would just put it in there as well. Um fts Coag and then HBA1C and thyroid. So that's a bit more specific. So you'd kind of be able to tell from their history whether or not they need that. Um ECG and echo. I mean, most patients when they come in, they have an ECG, but it's, it's more kind of if they've had a cardiac history. So if they've got any heart failure or any arrhythmias or anything like that, then you would do that um respiratory again, if they've got really severe COPD or they've had recurrent infections or anything like that, you probably want to do chest X ray and spirometry. Um just to see kind of again what their baseline is, how, well you think they'll function in the, um, kind of operation. You'd probably want to also, you could say I'm going to suggest these investigations. But, um, II could talk with the anesthetist and see if there's any further investigations that they think you might need, if they think you're high risk. Um, but lots of the time these patients won't be high risk, they'll just, I don't think they would give you someone that is really complicated. So I think these kind of things are less likely. It's more kind of your bloods. Maybe an ECG. Um, if it's a female, just check, if they could be pregnant. It is a childbearing age. Yeah. Just check that and then cardiopulmonary testing again. It's only if it's a major surgery or they're very high risk. So, you know, if they've got kind of like heart failure and lung disease and loads of kind of stuff going on, then you'd want to check that. So you can do like a fit test and see how much oxygen they need and everything when they're like cardioactive and stuff. So, yeah, but the main main investigations is just your bloods. Um, and I think that's all, that's why I think that's why I left it till last because I don't think you have to actually say that much. Whereas the other stuff you can go into a lot more detail. Um, this is also just the pre op checklist. So they do this. Um, basically you can let the patient know if you're talking about the day, you'll be like there's a checklist. So we make sure that we're doing the correct operation on the right person and we make sure that you've had kind of the medications that you need and we check, you know, before you go into, um, have your anesthesia before the surgery begins and then after the surgery has ended, just so that everything is regulated and we make sure that we're doing everything correctly. So it's another thing that you can say as kind of something to reassure the patient. So, yeah, these are kind of my top tips. So, um, how would you recommend talking through investigations with the patient? Because wouldn't a lot of it be jargon? Yes. So I would just say, um, so before we do your operation, we'll just have to do a couple of tests, um, today. Um, just so that we have a bit of a baseline of what's going on. We like to have a few blood tests so that we can look at your kidney function, um, to see how that's doing. Um, we also like to have a look at just kind of how your blood cells are, um, kind of your levels. Um, just to see if anything is kind of needed before the operation or if you're at risk of possibly needing, um, any blood or anything if you were to lose some blood. Um, we look at your kidney function just so that we can prescribe your medication correctly. Um, yeah, just make it very basic. Um, yeah, I don't, I don't really know how else I'd say it. Just say you're looking at the kidney function, you're looking at the levels in their blood. Um, it's mainly to see if they need, you know, they'd be at risk of a, um, anemia. Um, and just say that because then we will normally monitor you after your operation as well. So we'd like to see if there's any changes. Um, so that's how I'd make it kind of less jargon. So, yeah, top tips. So if they're childbearing age, ask if there's a risk of pregnancy, this is just a good one to get out of the way because you don't want to be operating on someone and not realize that they're pregnant. Um, yeah, so I said this before, don't just talk about the risks because a lot of that can just panic the patient. You want to also talk about the benefits. Um So, so they're having a knee operation. So this will help you with your mobility, you'll be able to walk. Um, hopefully a lot better. Um, and also will reduce the pain that you're currently having in your knee. It doesn't need to be massive, but then they'll normally go. Yes, that's why I've decided that I'm going to have it and you'll be like, ok, great. Um Yeah, so like I said, briefly, go through the risks. You can explain the anesthetist and the surgeon will come along on the day so they can explain the procedure and answer a lot more in a lot more detail than you can. Um Just so that the patient knows that. Um Yeah, make it personal. So I've said things like bring a book slippers, comfy clothes, Um let them know that they might be waiting around. Um Just so then they know what to expect because that's probably what you'd want to know. Um If you were a patient check in as you go along. So this station I'm not joking, you were literally just talking, talking, talking because you've got so much to get through. So after every single section, if you do it, how I've done it in kind of my sections just after every section, just check. Do you have any questions? Is do is everything understand? Do you understand everything about that? Um Because otherwise you might get to the end and be about to say, do you have any questions and then your timer goes. So it's just good to check as you go along. Um Yeah, when in doubt, say you can look things up or find a leaflet. That was kind of my thing for every single station. I think I offered everyone a leaflet and I said, oh, I'm not sure about that. Because you're not going to know everything. Um, but you can say I'll look it up and I'll get back to you about that. So, yeah. Um, and yeah, it's a lot to cover. You might think you've got a long time, but if you start kind of practicing these stations, um, you'll realize it's a lot to cover. So, just try and be as slick as you can. I mean, it's easier said than done, but the more you kind of practice it, if you write down exactly what you need to cover, you'll be able to just like rattle it off. So, yeah. Ok. So I've got a few cases so I haven't kind of made loads of slides on these because it is more of a history. So I kind of just wanted to like, um, pass it over to you guys. Um, so you can just put things in the chat if you don't mind. Obviously, if you don't, then it's not the end of the world, but it's probably better for kind of you guys if you do. So you're the F one and you're meeting Charlotte. She's a 23 year old female who is attending the pre op assessment clinic prior to her tonsillectomy. So, what medication changes did you have in your osk? Oh, I see. I don't actually remember. II block all my osk out. I was asking my friend this, I think I actually can't remember. I'd be lying to you, if I said that I knew. So I can't tell you that, but it was something but I don't think it was anything that complicated. But I'm sorry? Yeah. I don't know. But I think some of the other f ones were trying to, like, figure out what our stations were. But I will have to try and look at my feedback and see if I remember because I'm not gonna lie once I've done the Oscar, I just block it out because I don't want to remember what it is. So sorry that I can't answer that. Um Right. So if we're doing this station, I just kind of wanna know like what you guys, what you guys want to ask her. So what's kind of the important things to start, kind of asking her? And then I can kind of fill in on any information that you need. I ideas concerns expectations. Yeah. So she might say, yeah, I've come here today. Yeah, I understand why she needs to let me know what it is. Yeah, I can understand why she's having surgery. Yeah. So she comes back and says, um, I'm having the tonsillectomy because I've had tonsillitis so many times and they finally said that I can, um, get it done. Um, can you talk me through, you know, a bit about the operation? So, does anyone know anything about how a tonsillectomy is done? And does anyone know like some of the major kind of like risks of tonsillectomy. That's good. They will remove your tonsils. Wonderful bleeding. Yeah. So hemorrhage is one of the main kind of risks. So you could just say if you did have any bleeding even after you've gone home, after the operation, this is something that you will need to come back into hospital for. Um, because it is such a large risk infection as, as well. I think it's also quite important to kind of mention in tonsillectomies that this doesn't mean that tonsillitis will completely go away. You can still get basically infection. You just don't have the enlarged tonsils. So, um, that's why they're kind of reluctant of doing it because of the, um, risk of bleeding and stuff. But yeah, it will, at the end of the day it should improve her symptoms. Um, pain, POSTOP eating and drinking may be difficult for. Yeah, that's a really good thing to mention. Um, yeah. So if I say to you that her past medical history, she's got eczema, um, and she's got type one diabetes and she's also got, um, she's also on the pill. Oh, and she's got asthma. Just throw in there, then. What do we think we do about kind of like medication wise and stuff like that? Oh, allergies? Yeah, that's a really good one as well. At least, should always include that in your history. So, when you're doing your drug history, make sure to check for allergies stopped C ap. Yeah. How long before four weeks? Wonderful. Ok. Uh, modify insulin. Yeah. Pregnancy test. Yeah. Still important. I mean, even if she's on the pill you should still do a test. Yeah. HBA1C investigations. Yeah, we could do that just to see if it's kind of well controlled. She could be really poorly controlled diabetic. Um, and then if she is poorly controlled then we'd want to be kind of seeing, you know, that can make infection kind of less heal, heal better, not as heal as well. So, we want to make sure that she's well controlled. Um, what about her asthma? Anything you wanna know about her asthma? Yeah. Again, how called recent exacerbations? Yeah. Yeah. Yeah. Yeah. So, these are good to know. It's also good to know, like, has she ever been to it for asthma or anything like that? You're just trying to get the kind of, more of the history for the anesthetist to figure out if, um, you know, they might need a few more investigations done. Does ask my school for the A SA, by the way, I think it does. Um, but again, that's something you're not going to go into detail on this station. But I think it does. Um, yeah. So, yeah. So we've talked about why the clinic, we've talked about the operation. We've discussed the risk, the benefits, we've discussed kind of the medication changes and then kind of what's gonna happen on the day. Um, what do people think about, kind of like recovery and stuff? I know someone said that. Eating and drinking. Yeah. Ice cream and liquids. Perfect. Yeah. I think it's quite nice to make it quite lighthearted as well. Like, if it is a young patient having tonsillectomy, that's quite a nice thing to say. Lots of ice cream and stuff like that. Yeah, they should recover fairly quickly but then just make sure they know about the bleeding risk because I'd say that's kind of the main thing for the tonsillectomy. Yeah, I don't think there's any more to kind of say about this case. So, I mean, it's very like you don't need to do a lot for this station. As long as you've covered all this, then you've kind of got it ward for a few days to monitor recovery. How long we were not sore. So maybe our family to help back a few things. Yeah. Lovely. Exactly. Wonderful. Ok. Next case. So can they not go home straight away? Um, again, I don't actually know I'm on Ent next. So when I am on Ent, then I will figure that out. Um, but I think they normally like to monitor them for a while just to see if there is any bleeding. Um, so it might just be, they might have to stay for a day just to see how they're getting on. Um, yeah. Are we expected to do much POSTOP safety netting in this station. Not really. No, I wouldn't say so. Um, you could throw in kind of like a, a line just, you know, that if, you know, or depending on what operation they're having, if anything is kind of getting worse, like, or they're noticing any kind of infection or anything, then they can always come back or, you know, to seek medical attention. Um, but it's not something that it is not really a, um, part of the criteria for the Mark scheme. So I wouldn't worry too much about that one. Um, ok, so next one you're meeting Suzanne, she's a 52 year old female who is attending the pre op assessment clinic prior to her hysterectomy. So if we go through this again, so hysterectomy, does anyone kind of know how it's done the risks and benefits of the operation? Just briefly, it doesn't have to be in big detail. Obviously, again, you'll say why they're at the clinic. I mean, this is the one that we had last year. So this is one they could give again, but I don't know if they will, but does anyone know kind of risks benefits how the procedure is done at all? Laparoscopic surgery? No. So it's not always an open procedure so they can do it laparoscopically and actually pull it out via the vagina. Yeah, that's correct. Hannah. Um, so again, it depends on kind of the surgeon's opinion and it can also be converted midway um to open. Um So I think I remember telling the patient that just so that they were aware. Um So why is she having it as well? So you want to know that, you know, the reason why she's having it because if it's kind of a cancer thing or if it's something else, it's a key procedure with the can be infection damage to structures, ovaries, pain, arth also thing to watch out for. Yeah. So in this one, it will be a lot more about kind of the recovery process having people at home um to help them because they probably won't be able to do any kind of not much movement for a couple of days. Um They won't be able to do any like heavy lifting, they won't be able to drive. Um So it's just letting them know, however, so this um patient was having it because she's had um extremely heavy menstrual bleeding. Um So that's why she's having it. Um It could also be, it could be something to check if they've noticed anything. Um If they need to take any, like, look at the, what's the word, look at the uterus and see if there's any kind of like fibroids or anything in it. They might have identified a fibroid and actually that's what's causing the heavy bleeding. So that's why they're having it out. Um Yeah, so then if we go through our history, so past medical history wise, she's got Addison's and she, what else did I say that she had, she has heart failure. So, she's steroid controlled for Addison's and she's on Ramipril and Bisoprolol. Um, so what are we going to do about those kind of medications? IV. Yeah. Stop around for how long before? Yeah. Wonderful. Yeah. So that's fine. So, we'll do that. Um, and then again, has she had any surgeries or anything like that? It's all very repetitive. If you do that, it's fine. Um, on the day again, say what's going to happen, the recovery and then investigations wise, what do we think we will do for her? Yeah, that's another thing that you could talk about. You could just, um, you know, because she's only, I think, how old did I say she was 52? I mean, she's unlikely to have a family of 52. But again, you could do that again. Yeah, pregnancy test. Um, because you never know. Um Echo. Yeah. So this is something that because she's got heart failure, you might be thinking about doing an echo. You'd say maybe, um, have you had a recent scan of your heart or anything for heart failure? Um If you haven't had a recent kind of echo, we, we might want to do another one just prior to the operation. Um So just a, I always describe it to patients as kind of a jelly scar. A jelly scar, a jelly scan of the heart um, and then they kind of get what you're going on about. Um, yeah, and then how recent it is recent for ECG echo. I mean, probably if they've had an echo kind of in the last six months and they haven't had kind of any more leg swelling or they haven't had any kind of deterioration in the heart failure, then that would probably be enough if they've kind of been deteriorating and stuff like that, then you might need it more. Um ECG, it's hard because kind of they say kind of online that you don't need an ECG before surgery. But everyone gets an ECG like even when you come in, every, literally everyone gets an ECG. So I would just, if it in this patient in this instinct because they have heart failure, you'd want an up to date ECG. So I would just do the ECG anyway. Um Yeah, and then also you'd want for this patient, you'd probably want to do a cross match um and group and safe just because, you know, there, if it's going to be changed to open, they might need a blood transfusion. That's also something I didn't mention. So you could talk about, I think I did this as well. Thoughts on kind of their thoughts on if they needed a blood transfusion, would they be happy to have a blood transfusion? Um But again, that can be talked about, you know, on the day of the surgery but maybe just to kind of get there, you know, ideas about that. Um just in case. So, yeah, is there any kind of questions about that one? I don't think so. Ok, last one, I know these are really quick but it's more, it's when you, you just need to practice it with each other and kind of just do the history. Um That's kind of the best way to do it. This is just kind of getting you used to kind of the structure and just some specific things about some surgeries. Um Sister's last one. So you're meeting Darren. He's a 63 year old um who's attending the pre op assessment league. He's having a knee replacement. Um So what do we know about kind of knee replacement risks benefits? Septic arthritis? Yeah. Really painful. Yeah. Don't tell them that. Don't say it's really painful. Just say that they can have pain, infection. Yeah. Compartment syndrome. Yeah. Improve mobility. Yeah. Uni can be unstable. Yeah. Yeah. So I think when you, when you are mentioning the risks, you can just like I said, try and cover them, you know, you, you need to explain that, you know, they're having a foreign piece of equipment put into the body. So the body, you know, isn't quite used to that so they could get an infection. However, you know, everything's done extremely sterile, they'll be given antibiotics, things like that. Um Just so you're letting them know the risk, but then you're also letting them know kind of the um how to minimize the risks. Um Compartment syndrome. Yeah, that is, that is a risk. I don't know if you'd mention that to them in this kind of situation. I mean, they need to know it, but it's quite a difficult one to explain it. It just depends how much time you have. So it depends how quick you are. Um But yeah, benefits definitely to improve mobility. Um and everything like that. So yeah, um in their history, they um they have af so they're on Warfarin and they've also got CO PD so any kind of tests or medication changes that you can kind of think of um Warfarin five days before. Yeah. Ir Yeah, clotting profile on. Yeah, definitely. And you'll normally want to bridge. So to make sure that for Warfarin. Yeah. So they do. Normally the only thing is I'm not sure how this is actually done for surgery because obviously I don't know how they figure that out, but normally if they are an inpatient, so if they're already an inpatient for something kind of medical and then they need to go have an investigation or like a bronchoscopy or something like that, they either get changed from Warfarin to a Doac and then bridge that. So then you can stop the Doac 48 hours before or they just bridge it with the low me Heparin and then they stop that 24 hours before a month. Yeah, they have it for a while, I think. Yeah. I don't know. Exactly. Again, I'm not on surgery at the moment and some of my meds do not just kinda gone. But, yeah, that sounds about right. Um, yeah. And then, so the patient also has COPD. So it's just again figuring out how, well it's controlled how much kind of lung, lung damage there is, um, if they've had previous surgery before they could be, yeah, general anesthetic risk. So if they've had surgery before and actually they might turn around and say, yeah, it was really difficult to intubate me, then you can be like, ok, I'll make the anesthetist aware. Um They'll probably, they might want to even assess you not on the day of the operation, but maybe, you know, in another pre op assessment um that might need to happen if they've been kind of at risk before. Um Sorry, do you just stop the warfarin then? So you bridge it, you bridge the warfarin because you don't because you have to stop the warfarin for five days, you normally bridge it because you don't want to stop it for the full five days. So you'll start adding on kind of the delta and so that the inr is kind of in range and then you can stop the delta the day before if that makes sense. So then they're not completely without it. If that makes sense. Ok. Um, yeah, and then recovery wise, I mean, they're gonna be in pain, they're gonna, you know, they normally like to kind of like after joint replacements and stuff, they like to get them back up and moving as soon as possible. So you can say that, you know, it will be painful, but we like to try and improve start mobility as much as quickly as possible. So we'll make sure that you're on pain relief. And once you come out of the surgery, you know, people will be there to check that everything is ok and that if you do need any more pain relief, then you'll be able to get that. So, yeah, I think that's, yeah, that's everything that I was going to cover. Um If anyone's got any other questions, then let me know. But it is just kind of practice. I think once you've got the structure, you should be fine. It's quite an easy station to kind of nail. So, yeah. Oh, thanks guys. Yeah. Yeah. Thank you very much for um delivering that session. Would you just be able to flip to the um the feedback you could? Yeah. And then, uh so our next session will be on the 29th. Um Same time, same time as every week, there's a feedback link. If you scan it, you can get access to the catch up content. Um We will stick around for another 10 minutes. Well, yeah, another 10 minutes. Or so until, until about 10 past eight and then uh we'll close the meeting. So if you have any questions, just post them in the chart and we'll answer them. Yeah. Sorry, I don't know if you can see there are a couple of questions um, that flo through in the, in the chat. Yeah, I'm just trying to look at them um, double check. Do the patients have any specific questions? No, I don't think they have any kind of specific questions they might do if you ask them, but not that I think if you cover everything kind of in the list, then they won't. But if you don't cover everything, then they'll probably prompt you with a question. Um, so for example, if you don't cover their medications, they could, if they were feeling nice, be like, oh, I'm on this. Does, does this need to change or? But I don't think they'll have any kind of specific questions really? Um, just a general question for Os histories? How much do you tell? Do they ask about medical positions? Do they want us? How much? So general General Os, um, I think in this fifth year there's not, the histories are kind of all quite specific. Um, so it is normally kind of more relevant to the presenting complaint, but I don't know, you need to cover your kind of history how you've learned it, but it is more specific. So I'd say it's more to the presenting complaint, if you have time, maybe do kind of a top to toe. Um, and ask, just ask them about medical conditions. But lots of the time in acies in general, they, they don't have massive really complex histories like they don't. Um, so when, if you ask them, if they've got any medical conditions, they'll give you the stuff that you need to know and that's important. So, yeah, but when you are to, it's more to the presenting complaint. But if you're just asking past medical history, then they should be able to tell you the ones that they need to tell you that you need to know if that makes sense because it's a short section. Should we not check patient understanding? Yes, I mean, you can do but once you start, you can kind, yeah, that's why I say about kind of the checking in every things and every time like you complete a little section just be like, do you understand? Yeah. Do you, do you have any questions? Do you kind of get what I've said there um about your, any medication changes and stuff. So, yeah, you are, when you're asking if they've got any questions, you're also kind of checking in with their patient understanding if that is ok.